Height‐based equations as screening tools for elevated blood pressure in the SAYCARE study

Abstract

This study evaluated the accuracy of four height-based equations: blood pressure to height ratio (BPHR), modified BPHR (MBPHR), new modified BPHR (NMBPHR), and height-based equations (HBE) for screening elevated BP in children and adolescents in the SAYCARE study. We measured height and BP of 829 children and adolescents from seven South American cities. Receiving operating curves were used to assess formula performance to diagnose elevated BP in comparison to the 2017 clinical guideline. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for the four screening formulas. The diagnostic agreement was evaluated with the kappa coefficient. The HBE equation showed the maximum sensitivity (100%) in children, both for boys and girls, and showed the best performance results, with a very high NPV (>99%) and high PPV (>60%) except for female children (53.8%). In adolescents, the highest sensitivity (100%) was achieved with the NMBPHR for both sexes. Kappa coefficients indicated that HBE had the highest agreement with the gold standard diagnostic method (between 0.70 and 0.75), except for female children (0.57). Simplified methods are friendlier than the percentile gold standard tables. The HBE equation showed better performance than the other formulas in this Latin American pediatric population.

Height‐based equations as screening tools for high blood pressure in pediatric practice, the GENOBOX study

“…In addition, these results were observed with similar cut‐off points to those obtained in previous studies. 22 , 30 , 31 …”

“… 24 In a recent study performed in South America, the HBE was the equation with the best performance to identify elevated blood pressure (> P90th, according to the AAP CPG), showing also a high sensitivity, NPV and a PPV above 53.8, with male children and adolescents showing the maximum PPV values (72.6 and 63.2, respectively). 22 …”

“…In addition, these results were observed with similar cut-off points to those obtained in previous studies. 22,30,31 Di Bonito and coworkers 23 created the NSF based on the 2017 AAP CPG especially for children with overweight or obesity and obtained a good PPV (84-83%). 23 In our study, although we found a lower PPV both in boys and girls, when data were analyzed by weight status, the analysis in children with overweight or obesity showed an increase in PPV compared to children with normal weight (69.4-69.1% vs. 50.8-…”

“…NPV and a PPV above 53.8, with male children and adolescents showing the maximum PPV values (72.6 and 63.2, respectively). 22 It is well known that children with overweight or obesity have higher prevalence of hypertension than children with normal weight. 33 For this reason, when other studies studied the performance of the different equations according to weight status, the subgroups with overweight or obesity showed better PPV.…”

“… 14 For this reason, only some authors have tested the usefulness of these formulas based on the 2017 guideline. 22 While other authors have proposed new formulas adapted to the 2017 guideline. 23 , 24 Nevertheless, no study has been found in a pediatric Spanish population using any of the mentioned formulas.…”